Liberty Ave Pharmacy,Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

024286 Issued in NY

Legal business name

LIBERTY AVE PHARMACY,INC

Practice address

1108 Liberty Ave
Brooklyn, NY 11208-2922

Phone

(718) 827-7528

Fax

(718) 277-0193

NPI assigned

Feb 24, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Abu S Azam, RPH.

Title

SP

Phone

(718) 827-7528

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1669508818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1108 LIBERTY AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112082922",
            "telephone_number": "718-827-7528",
            "fax_number": "718-277-0193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1108 LIBERTY AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112082922",
            "telephone_number": "718-827-7528",
            "fax_number": "718-277-0193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY AVE PHARMACY,INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "AZAM",
        "authorized_official_first_name": "ABU",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "SP",
        "authorized_official_telephone_number": "718-827-7528",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NY",
            "license": "024286",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01900921",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dennies Libert, LMSW
• John Libertella, D.P.M.
• Rosemary Libertella
• Liberty Audiology of New York PC
• Liberty Audiology of New York PC
• Liberty Care Medical PC
• Liberty Drug Inc
• Liberty Hearing Center
• Liberty Hearing Center
• Liberty Medical Device

• Community/Retail Pharmacy in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Community/Retail Pharmacy in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.